Search

# Background Under-5 deaths in urban slum communities are often unnoticed in many cases. However, previous surveys reported a high burden of mortality. Therefore, we presented the distribution of the causes of death of under-5 children in selected urban slum areas in Bangladesh. # Methods Since October 2020, the Urban Health and Demographic Surveillance System (Urban HDSS) has been collecting verbal autopsy information for neonates, children, and adults to report the causes of death. We used the data collected by the trained Field Workers- from all households (30,857) in the ongoing HDSS area, comprising 118,238 people. The causes of deaths were identified by using the WHO-standardized verbal autopsy (VA) questionnaire that was reviewed and coded by a trained physician. Later, the cause-specific fractions of the deaths were evaluated by the child’s age, sex, the mother’s education, occupation, household wealth quintile, slum locations, mode and place of delivery, and antenatal and postnatal care. # Results A total of 155 deaths of children under-5 years were interviewed during October 2020–2021. Most of them were neonates (67.7%), boys (67.7%), belonged to poor households (43.9%), born at home (51%) and had vaginal delivered (77%). Most of the mothers of the deceased children took antenatal care services (80%), and a comparatively lower proportion received postnatal care (39.3% and 47.1% of mothers and children, respectively). In this slum area, birth asphyxia (25.2%) was the major leading cause of under-5 deaths occurred in the neonatal period (37.1%), followed by other infections (14.2%) and pneumonia (16.1%). Other important causes of death were cerebral ischemia (7.7%), prematurity and low birth weights (6.5%), congenital anomalies (5.2%), and other external causes (18.1%), contributed to the under-5 child deaths. The cause of mortality fraction varied by different socioeconomic and delivery-related attributes such as place, mode of delivery, and utilization of ANC and PNC visits. # Conclusions Major causes of under-5 death are birth asphyxia, pneumonia, and infectious diseases. Adequate attention and additional safety measures, education and awareness about child’s health among mothers, and proper delivery care for pregnant slum women and children could prevent under-5 deaths in the slum area.

Background: Coronavirus disease 2019 (COVID-19) has spread globally, and the government of each affected country is publishing the number of deaths every day. This official figure is an underestimate as it excludes anybody who did not die in a hospital, who did not test positive, who had a false result, or those who recovered on their own without a test.Objective: This study aimed to measure the community level excess mortality using health and demographic surveillance in a rural area of Bangladesh.Method: The study was conducted in Matlab, in a rural area of Bangladesh, with a Health and Demographic Surveillance System (HDSS) covering a population of 239,030 individuals living in 54,823 households in 142 villages. We examined the mortality in January-April from 2015 to 2020 and compared the mortality in 2020 with the historical trend of 2015–2019. Between 2015 and 2020, we followed 276,868 people until migration or death, whichever occurred first. We analyzed mortality using crude mortality rate ratio (MRR) and adjusted MRR (aMRR) from a Cox proportional hazard model. Mortality was analyzed according to age, sex, and period.Results: During follow-up, 3,197 people died. The mortality rate per 1,000 person-years increased from 10 in 2019 to 12 in 2020. Excess mortality was observed among the elderly population (aged 65 years and above). The elderly mortality rate per 1,000 person-years increased from 80 in 2019 to 110 in 2020, and the aMRR was 1.40 (95% CI: 1.19–1.64). Although an increasing tendency in mortality was observed between 2015 and 2019, it was statistically insignificant.Conclusions: The study reported a 28% increase in excess deaths among the elderly population during the first months of the pandemic. This all-cause mortality estimation at the community level will urge policymakers, public health professionals, and researchers to further investigate the causes of death and the underlying reasons for excess deaths in the older age-group.

Abstract Background There is increasing interest in using verbal autopsy to produce nationally representative population-level estimates of causes of death. However, the burden of processing a large quantity of surveys collected with paper and pencil has been a barrier to scaling up verbal autopsy surveillance. Direct electronic data capture has been used in other large-scale surveys and can be used in verbal autopsy as well, to reduce time and cost of going from collected data to actionable information. Methods We collected verbal autopsy interviews using paper and pencil and using electronic tablets at two sites, and measured the cost and time required to process the surveys for analysis. From these cost and time data, we extrapolated costs associated with conducting large-scale surveillance with verbal autopsy. Results We found that the median time between data collection and data entry for surveys collected on paper and pencil was approximately 3 months. For surveys collected on electronic tablets, this was less than 2 days. For small-scale surveys, we found that the upfront costs of purchasing electronic tablets was the primary cost and resulted in a higher total cost. For large-scale surveys, the costs associated with data entry exceeded the cost of the tablets, so electronic data capture provides both a quicker and cheaper method of data collection. Conclusions As countries increase verbal autopsy surveillance, it is important to consider the best way to design sustainable systems for data collection. Electronic data capture has the potential to greatly reduce the time and costs associated with data collection. For long-term, large-scale surveillance required by national vital statistical systems, electronic data capture reduces costs and allows data to be available sooner.

# Background This study investigated healthcare decision-making surrounding terminal illnesses of adults and elderly persons (aged 15 years or more), who later died at home, hospitals, or in-transit, in a rural, low-income area of Bangladesh where out-of-pocket health expenditure is very high. # Methods There were 1330 adult and elderly deaths in Matlab Health and Demographic Surveillance site in 2013. To record how decisions were made and implemented when caring for terminal illness, and how treatment-related costs were managed, the main caregivers of 69 randomly selected persons who died at home, 74 who died in hospitals, and 11 who died in-transit were interviewed with a social autopsy questionnaire in 2014. Differences between groups were tested by χ^2^ for significance at *P* \